Ohio will forgo $13 billion in federal aid over the next seven years that would have paid for
health care for thousands of uninsured Ohioans under a budget plan House GOP leaders will unveil
this afternoon.

Concerned about federal spending and facing immense pressure from tea-party-affiliated groups,
Republican leaders will strip Gov. John Kasich’s proposed Medicaid expansion from the two-year
budget. The entire cost of covering 275,000 more adults without health insurance would have been
paid by the federal government under Obamacare for three years. It also would have saved Ohio
taxpayers $400 million over the next two years.

Instead, Republicans reportedly will propose providing $50 million a year in state funds for
mental-health and addiction services. Kasich had said his expansion plan would free up more than
$100 million in local levy dollars for mental health and addiction.

Supporters of the Medicaid expansion note that lawmakers not only will forgo the billions in aid
from Washington, they also will give up $400 million in savings and spend an additional $100
million in state tax dollars instead of using federal money to free up local levy money for
mental-health and addiction services.

“Investment in mental-health and addiction services is both great and needed, but not a
substitute to an extension of health-care coverage,” said Julie DiRossi-King, director of
government affairs for the Ohio Association of Community Health Centers. “What does that do for the
uninsured patient with a lump in her breast? Or the uninsured veteran with high blood pressure who
faces far worse health outcomes, potential hospitalization or worse if left unmanaged?”

According to the Obama administration, about half of those covered by the expansion to 138
percent of the federal poverty level — $23,050 for a family of four — work but do not have health
insurance.

“If Ohio chooses not to expand Medicaid, we are going to be left with serious gaps in coverage,”
DiRossi-King said, noting that someone earning 200 percent of the federal poverty level could get
coverage, but a person with no kids making 95 percent could not.

Republicans also rejected an alternative that, if approved by federal regulators, would have set
up a three-year pilot program in which Medicaid funds would have been used to purchase private
insurance coverage for the expansion population.

Jon Allison, leader of the Ohio Alliance of Health Transformation, a coalition of community
organizations, businesses groups, health-care providers and religious organizations pushing for the
Medicaid expansion, said more than 1,000 people plan to rally at the Statehouse on Thursday as
efforts continue to try to get some type of expansion approved before a House vote next week.

“From our perspective, it was always critical that the governor’s Medicaid proposal, maybe not
exactly how he proposed it, needed to pass the House because our likelihood of success in the
Senate is a question mark,” Allison said.

The feeling among supporters is that, politically, the Senate would have a hard time stripping
the Medicaid expansion out of the budget if the House approves it. Conversely, they know that
considering some recent critical statements from Senate President Keith Faber, R-Celina, they will
have a tough time getting the GOP-dominated Senate to add the expansion if the House strips it
out.

Allison, a former chief of staff for Gov. Bob Taft, said it’s a tough issue for House
Republicans, and he has heard a number express concern about the size of the federal deficit and
the mistrust of the federal commitment to the Medicaid expansion. A handful also are being
influenced by tea-party primary election threats, Allison said.

“Unfortunately, for enough members of the House Republican caucus, it’s coming down to politics
over people.”

A trigger in Kasich’s expansion plan, or the proposed three-year pilot program floated by some
House Republicans, are two good ideas to protect Ohio if the federal government doesn’t fulfill its
promises, he said.

“As a lifelong Republican, I absolutely respect genuine concern about our nation’s deficit,”
Allison said. “But what can a state legislator really do to fix something that Congress and the
president are unable to fix?

“Like it or not, the Affordable Care Act is the law of the land,” he added. “Barack Obama was
re-elected, and there’s no ability in Congress to change this. Because we don’t have perfection,
are elected officials really going to throw this all out?”

Sources indicated that about 40 of 60 House Republicans said they would vote to support the
Medicaid expansion, short of the majority 50. With Speaker William G. Batchelder of Medina among
those opposed to the expansion, it became very difficult to win additional votes.

Many House Democrats support the Medicaid expansion, but few, if any, are expected to vote for
it as part of Kasich’s overall $63.3 billion two-year budget.